Transfusion reactions

Question 1

What are the signs of a haemolytic transfusion reaction in an anaesthetised patient?

Answer 1

Signs of rbc destruction along with other signs of an immunological reaction:
Wheeze, bronchospasm, tachypnoea, hypoxia
Tachycardia, hypotension, CV collapse
Oedema, urticaria
DIC–> bleeding (membranes, infusions sites), cola-coloured urine

Question 2

What causes haemolytic transfusion reaction?

Answer 2

It’s either intra-vascular haemolysis (the more severe form) with complement activation via IgM as a result of ABO incompatibility)=
or extra-vascular haemolysis (less severe) with IgG antibodies coating antigen as a result of D antigen

Question 3

What are the steps if suspect a haemolytic transfusion reaction?

Answer 3

Cease transfusion of the blood product & change the IV tubing
Call for help, communicate the situation, delegate
Titrate FiO2 to maintain adequate SpO2
Treat hypotension w IVT & vasoactive agents
Rx focused on circulatory support, alleviating resp symptoms & anticipating/managing any coagulopathy
Insert art line for ABGs & monitoring
Once haemodynamically stable, consider CVC & IDC
Maintain urine output @ least 0.5mL/kg/hr with diuretic & inotropic support
Treat any developing coagulopathy in conjunction with transfusion/haematology/ICU
Return all products to blood bank (they should be immediately informed & products to be rechecked against the pt), take fresh blood & urine samples for analysis

Disposition= ICU

Blood from opposite arm for repeat X-match
No steroids for TRALI or haemolysis

Question 4

What’s the target urine output during haemolytic transfusion reaction & how achieve this?

Answer 4

0.5-1.5mL/kg/hr, with:

Diuretics:

• frusemide 0.5mg/kg IV
• mannitol 25% 0.5-1g/kg IV
• methylprednisolone 1-3mg/kg IV

or with inotropes, commencing infusions @ 5mL/hr for a 70kg adult then titrating to response:

• Adr 3mg/50mL saline (60microg/mL)
• Dobutamine 250mg in 50mL saline (5mg/mL)
• NAdr 3mg/50mL saline (60microg/mL)

Question 5

What helps differentiate btwn TACO & haemolytic transfusion reaction? TRALI?

Answer 5

TACO signs of CCF, raised BNP, HTN.
Haemolytic transfusion reaction: haemolytic screen
TRALI: can be impossible to differentiate from other causes of ARDS; Dx of exclusion; hypoT, fever, timing 2-6hrs after supportive. Management= supportive (supplemental O2+/- mech vent, inotropes if needed). avoid diuretics. Subsequent transfusions from a different donor. Usually resolves over 48hrs but can take 7 days. high mortlity rate. test donors for HLA & anti-neutrophil antibodies.

Question 6

What helps differentiate btwn TACO & haemolytic transfusion reaction? TRALI?

Answer 6

TACO signs of CCF, raised BNP, HTN.
Haemolytic transfusion reaction: haemolytic screen
TRALI: can be impossible to differentiate from other causes of ARDS; Dx of exclusion; hypoT, fever, timing 2-6hrs after supportive. Management= supportive (supplemental O2+/- mech vent, inotropes if needed). avoid diuretics. Usually resolves over 48hrs but can take 7 days. high mortlity rate. test donors for HLA & anti-neutrophil antibodies.

Question 7

what’s involved in haemolytic screen?

Answer 7

Hb
blood film
reticulocytes
Haptoglobin
direct coomb’s (usually detects autoimmune haemolysis eg. complement (from IgM) or IgG bound to red cells
indirect coombs: detects antibodies bound to red cells
lactate
LDH
haemosiderin urine